膈肌下抬挤心脏复苏法对开腹手术中心搏骤停兔血流动力学及心肌细胞凋亡的影响(1)
【摘要】目的 观察膈肌下抬挤心脏复苏法(cardiopulmonary resuscitation under the diaphragmatic muscle，D-CPR)和常规胸外心脏按压法(standard cardiopulmonary resuscitation，S-CPR)对心搏骤停(cardiac arrest，CA)兔CA至自主循环恢复(return of spontaneous circulation，ROSC)时间、血流动力学、ROSC率、6 h生存率、心肌细胞caspase3的表达及心肌细胞凋亡的影响，探讨D-CPR的复苏机制，为开腹手术中发生的CA选择更合适的复苏方法提供参考。方法 32只健康新西兰兔随机(随机数字法)分为：D-CPR组、S-CPR组，每组16只。腹腔注射氯氨酮、速眠新合剂，气管切开后插入气管导管，分离右颈内静脉、左侧颈总动脉，于左侧颈总动脉插入静脉留置针，监测动脉压，右侧颈内静脉插入中心静脉导管监测中心静脉压(central venous pressure，CVP)，通过体表监测并记录Ⅱ导联心电图；模拟开腹手术操作，待动物生命体征平稳5 min后，于呼气末夹闭气管导管，持续8 min，制作窒息性CA模型。心电图示无脉性电活动或心室停搏后，不作干预，2 min后采用D-CPR或S-CPR进行心肺复苏，观察两种复苏方法的复苏效果，对比两组动物CA至ROSC的时间、血流动力学变化、ROSC率及6 h生存率的不同，检测复苏成功6 h后兔心肌细胞组织形态学改变和心肌细胞caspase3的表达，以及心肌细胞凋亡指数(apoptotic index，AI)。结果 ①CA至ROSC时间：D-CPR组显著低于S-CPR组；②CPR 15 min内冠脉灌注压(coronary perfusion pressure，CPP)、平均动脉压(mean arterial pressure，MAP)变化：D-CPR组CPP、MAP明显高于S-CPR组(P<0.05)。③ROSC后SBP、DBP变化：D-CPR组明显高于S-CPR组(P<0.05)。④ROSC率：D-CPR组的ROSC率显著高于S-CPR组，81%vs.43%，P<0.05。⑤6 h存活率：D-CPR组6h存活率明显高于S-CPR组，75%vs.25%，P<0.05。⑥HE染色：D-CPR组心肌损伤较轻，心肌细胞水肿较轻，细胞界限清楚，S-CPR组心肌损伤较重，心肌细胞水肿，细胞界限不清，片状坏死，伴少许炎细胞浸润。⑦心肌细胞caspase3表达：D-CPR组心肌caspase3阳性细胞累积光密度(integrated optical density，IOD)明显低于S-CPR组(P<0.05)。⑧心肌细胞AI检测：D-CPR组心肌细胞AI明显低于S-CPR组(P<0.05)。结论 ①D-CPR较S-CPR产生更好的血流动力学效果，显著提高CPP、MAP，提高ROSC率及6 h生存率，提示在开腹手术中发生CA采用D-CPR可能比S-CPR更为有效。②D-CPR具有较高的ROSC率及6 h生存率，可能与其缩短CA至ROSC的时间，减少心肌细胞caspase3表达，减少心肌细胞凋亡，减轻缺血-再灌注后心肌细胞损伤程度有关。
, http://www.100md.com
【关键词】心搏骤停；膈肌下抬挤；血流动力学；凋亡；Caspase3； 缺血-再灌注损伤
The effect of cardiac massage by subdiaphragmatic compression on hemodynamics and apotosis of myocardial cells of rabbit with cardiac arrest during abdomen operations GU Cai-hong，WANG Li-xiang，XU Tie，LIU Ke-xi，WANG Yan-li. ICU of Emergency Department，Affiliated First Hospital of Lianyungang， Lianyungang 222000，China
Corresponging author：GU Cai-hong；Email guch80@163.com
, 百拇医药
【Abstract】Objective To observe the effect of cardiac massage by subdiaphragmatic compression (D-CPR) on the length of time required from cardiac arrest (CA) to restoration of spontaneous circulation (ROSC)，hemodynamics，rate of ROSC，survival rate of 6 h，level of Caspase3 in myocardial cells and apoptosis index (AI) of myocardial cells and compare the effect of standard cardiac massage by chest compression (S-CPR) on those variables in order to choose the more effective resuscitation method for the patient with CA during abdomen operations.Methods A total of 32 healthy New Zealand rabbit were randomly(random number) divided into two groups， namely S-CPR group and D-CPR group (n=16 in each group).All of rabbits were anesthetized with ketamine and Shumianxin (a kind of hypnotics) by intraperitoneal injection，subsequently tracheotomy was made for endotracheal intubation， and right internal jugular vein was catheterized for monitoring central venous pressure (CVP) and left common carotid artery was for indwelling cannula to monitor arterial blood pressure.Lead-2 of ECG was placed. After laparotomy and vital signs of rabbits stabilized for 5 minutes， the endotracheal tube was clamped at the end expiration for 8 minutes to make asphyxial cardiac arrest model. The effects of two different methods were observed and compared in respects of changes in hemodynamics、length of time elapsed from CA to ROSC、ROSC rate and the survival rate in 6 h.The level of Caspase3 in myocardial cells and AI of myocardial cells were detected by using immunohistochemistry staining method and TUNEL， respectively 6 hours after successful resuscitation.Results ①The length of time consumed from CA to ROSC in D-CPR group was shorter than that in S-CPR group (P<0.05) ②Coronary perfusion pressure (CPP) and MAP 15 minutes after CPR were higher in D-CPR group than those in S-CPR group (P<0.05). ③SBP and DBP after ROSC were higher in D-CPR group than those in S-CPR group. ④ROSC rate in D-CPR group was significantly higher than that in S-CPR group (81% vs. 43%， P<0.05). ⑤Survival rate in 6h in D-CPR group was substantially higher than that in S-CPR group (75% vs. 25%， P<0.05). ⑥HE staining showed that severe myocardial damage manifesting in edema of myocardial cell，indistinguishable cell boundary， and patchy necrosis with infiltration of scanty inflammatory cells were found in S-CPR group. While in D-CPR group， mild myocardial damage in form of slight cellular edema and distinctive cell boundary was observed. ⑦Level of Caspase3 in myocardial cells in terms of integrated optical density (IOD) of postive Caspase3 cells was substantially lower in D-CPR group than that in S-CPR group (P<0.05). ⑧Apoptosis index (AI) of cells was lower in D-CPR group than that in S-CPR group (P<0.05).Conclusions ①The hemodynamics in D-CPR group was more stable than that in S-CPR.group， and D-CPR increased CPP，MAP，ROSC rate and survival rate in 6h，improving achievement of successful resuscitation. ② D-CPR was more effective in terms of shortening the length of time for restoration of spontaneous circulation、decreasing level of Caspase3 in myocardial cells、decreasing apoptosis index of myocardial cells and ameliotating myocardial damage from ischemic reperfusion injury.
, http://www.100md.com(顾彩虹 王立祥 许铁 刘克喜 王言理)
, http://www.100md.com
【关键词】心搏骤停；膈肌下抬挤；血流动力学；凋亡；Caspase3； 缺血-再灌注损伤
The effect of cardiac massage by subdiaphragmatic compression on hemodynamics and apotosis of myocardial cells of rabbit with cardiac arrest during abdomen operations GU Cai-hong，WANG Li-xiang，XU Tie，LIU Ke-xi，WANG Yan-li. ICU of Emergency Department，Affiliated First Hospital of Lianyungang， Lianyungang 222000，China
Corresponging author：GU Cai-hong；Email guch80@163.com
, 百拇医药
【Abstract】Objective To observe the effect of cardiac massage by subdiaphragmatic compression (D-CPR) on the length of time required from cardiac arrest (CA) to restoration of spontaneous circulation (ROSC)，hemodynamics，rate of ROSC，survival rate of 6 h，level of Caspase3 in myocardial cells and apoptosis index (AI) of myocardial cells and compare the effect of standard cardiac massage by chest compression (S-CPR) on those variables in order to choose the more effective resuscitation method for the patient with CA during abdomen operations.Methods A total of 32 healthy New Zealand rabbit were randomly(random number) divided into two groups， namely S-CPR group and D-CPR group (n=16 in each group).All of rabbits were anesthetized with ketamine and Shumianxin (a kind of hypnotics) by intraperitoneal injection，subsequently tracheotomy was made for endotracheal intubation， and right internal jugular vein was catheterized for monitoring central venous pressure (CVP) and left common carotid artery was for indwelling cannula to monitor arterial blood pressure.Lead-2 of ECG was placed. After laparotomy and vital signs of rabbits stabilized for 5 minutes， the endotracheal tube was clamped at the end expiration for 8 minutes to make asphyxial cardiac arrest model. The effects of two different methods were observed and compared in respects of changes in hemodynamics、length of time elapsed from CA to ROSC、ROSC rate and the survival rate in 6 h.The level of Caspase3 in myocardial cells and AI of myocardial cells were detected by using immunohistochemistry staining method and TUNEL， respectively 6 hours after successful resuscitation.Results ①The length of time consumed from CA to ROSC in D-CPR group was shorter than that in S-CPR group (P<0.05) ②Coronary perfusion pressure (CPP) and MAP 15 minutes after CPR were higher in D-CPR group than those in S-CPR group (P<0.05). ③SBP and DBP after ROSC were higher in D-CPR group than those in S-CPR group. ④ROSC rate in D-CPR group was significantly higher than that in S-CPR group (81% vs. 43%， P<0.05). ⑤Survival rate in 6h in D-CPR group was substantially higher than that in S-CPR group (75% vs. 25%， P<0.05). ⑥HE staining showed that severe myocardial damage manifesting in edema of myocardial cell，indistinguishable cell boundary， and patchy necrosis with infiltration of scanty inflammatory cells were found in S-CPR group. While in D-CPR group， mild myocardial damage in form of slight cellular edema and distinctive cell boundary was observed. ⑦Level of Caspase3 in myocardial cells in terms of integrated optical density (IOD) of postive Caspase3 cells was substantially lower in D-CPR group than that in S-CPR group (P<0.05). ⑧Apoptosis index (AI) of cells was lower in D-CPR group than that in S-CPR group (P<0.05).Conclusions ①The hemodynamics in D-CPR group was more stable than that in S-CPR.group， and D-CPR increased CPP，MAP，ROSC rate and survival rate in 6h，improving achievement of successful resuscitation. ② D-CPR was more effective in terms of shortening the length of time for restoration of spontaneous circulation、decreasing level of Caspase3 in myocardial cells、decreasing apoptosis index of myocardial cells and ameliotating myocardial damage from ischemic reperfusion injury.
, http://www.100md.com(顾彩虹 王立祥 许铁 刘克喜 王言理)